Minority populations may experience poorer health status than the majority because they receive proven effective health care services less often. Improving patient self-management is most likely a critical leverage point in improving the delivery of effective care. Interventions to increase the delivery of effective health care services are likely to be most effective if they are carefully tailored to address the specific causes of the under use problems they seek to remedy. We have many multi-institutional research and community outreach projects underway now to improve the delivery of effective care to the minority communities of East and Central Harlem in New York City. We propose to develop our Center around the theme of improving health and reducing disparities by enhancing self-management skills among patients in East and Central Harlem. Our Center's research core will enhance 2 already-funded intervention trials to examine the effectiveness of a peer-led patient support group intervention (one in patients with uncontrolled hypertension and a second in those with stroke); we will add to a third already-funded trial an intervention that will match women with early-stage breast cancer and specific needs for support to existing community services. A vigorous community outreach core that will aim to embed successful programs in the community to maximize the likelihood that they will remain after the research studies are concluded will supplement these research strategies. We will strengthen existing linkages and build new ones with community leaders and organizations to maintain a mutual exchange of information between the community, researchers, and educators. Our Center will pursue complementary objectives in its training activities. We propose to deepen our partnership with North General Hospital, the only private hospital other than Mount Sinai in East or Central Harlem. We will involve North General in the enhancements to our research studies, as we have with the already-funded research. We will inaugurate a multi-faceted clinical research training program that will introduce clinical research concepts and methods broadly and engage selected North General faculty more intensively to enhance the minority health services research infrastructure in our community and to facilitate the entry of minority faculty into research careers.